, Volume 55, Issue 5, pp 585–594 | Cite as

Variations in the origin of the vertebral artery and its level of entry into the transverse foramen diagnosed by CT angiography

  • Akira Uchino
  • Naoko Saito
  • Masahiro Takahashi
  • Yoshitaka Okada
  • Eito Kozawa
  • Naoko Nishi
  • Waka Mizukoshi
  • Reiko Nakajima
  • Yusuke Watanabe
Diagnostic Neuroradiology



The origin of the vertebral artery (VA) varies, though most VAs enter the transverse foramen (TF) of the sixth cervical vertebra. On computed tomography (CT) angiographic images, we evaluated the prevalence of variations of both VA origin and its level of entry into the TF.


We retrospectively reviewed CT angiographic images of 2,287 patients obtained using either of two 64-slice multidetector CT scanners. All patients were Japanese and underwent scanning from the aortic arch to the intracranial region; most had or were suspected of having cerebrovascular diseases.


The left VA (LVA) arose from the aorta between the left common carotid artery and left subclavian artery in 94 patients (4.1 %) and in other variations in 44 patients (1.9 %). The right VA (RVA) arose from the extreme proximal segment of the right subclavian artery in 72 patients (3.1 %) and in other variations in 14 patients (0.6 %). The LVA entered the sixth TF in 2,127 patients (93.0 %), and the RVA entered the sixth TF in 2,146 patients (93.8 %). Anomalous origin and anomalous entry level into the TF correlated strongly.


The total prevalence of variation in the origin of the LVA was 6.0 % and of the RVA, 3.8 %. The total prevalence of variation in entry level into the TF was 7.0 % for the LVA and 6.2 % for the RVA. Recognition and reporting of these variations is important in interpreting CT angiography to prevent complications during surgery of the aortic arch or lower neck.


Aortic arch Arterial variation CT angiography Transverse foramen Vertebral artery 



We thank Tatsuya Umezawa, R.T. and Itsuki Nagazumi, R.T., for their contribution to CT angiography, and Rosalyn Uhrig, M.A., for editorial assistance in the preparation of this manuscript.

Conflict of interest

We declare that we have no conflict of interest.


  1. 1.
    Adachi B (1928) Das arteriensystem der Japaner, vol 1. Maruzen, Kyoto, pp 138–155Google Scholar
  2. 2.
    Berko NS, Jain VR, Godelman A, Stein EG, Ghosh S, Haramati LB (2009) Variants and anomalies of thoracic vasculature on computed tomographic angiography in adults. J Comput Assist Tomogr 33:523–528PubMedCrossRefGoogle Scholar
  3. 3.
    Jakanani GC, Adair W (2010) Frequency of variations in aortic arch anatomy depicted on multidetector CT. Clin Radiol 65:481–487PubMedCrossRefGoogle Scholar
  4. 4.
    Müller M, Schmitz BL, Pauls S, Schick M, Röhrer S, Kapapa T, Schlötzer W (2011) Variations of the aortic arch—a study on the most common branching patterns. Acta Radiol 52:738–742PubMedCrossRefGoogle Scholar
  5. 5.
    Koenigsberg RA, Pereira L, Nair B, McCormick D, Schwartzman R (2003) Unusual vertebral artery origins: examples and related pathology. Catheter Cardiovasc Interv 59:244–250PubMedCrossRefGoogle Scholar
  6. 6.
    Goray VB, Joshi AR, Garg A, Merchant S, Yadav B, Maheshwari P (2005) Aortic arch variation: a unique case with anomalous origin of both vertebral arteries as additional branches of the aortic arch distal to left subclavian artery. AJNR Am J Neuroradiol 26:93–95PubMedGoogle Scholar
  7. 7.
    Hsu DP, Alexander AD, Gilkeson RC (2010) Anomalous vertebral artery origins: the first and second reports of two variants. J Neurointervent Surg 2:160–162CrossRefGoogle Scholar
  8. 8.
    Yamashiro S, Kuniyoshi Y, Arakaki K, Inafuku H, Morishima Y, Kise Y (2010) Total arch replacement with associated anomaly of the left vertebral artery. Ann Thorac Cardiovasc Surg 16:216–219PubMedGoogle Scholar
  9. 9.
    Kiss J (1968) Bifid origin of the right vertebral artery: a case report. Radiology 91:931PubMedGoogle Scholar
  10. 10.
    Suzuki S, Kuwabara Y, Hatano R, Iwai T (1978) Duplicate origin of left vertebral artery. Neuroradiology 15:27–29PubMedCrossRefGoogle Scholar
  11. 11.
    Nishijima M, Harada J, Akai T, Endo S, Takaku A (1989) Operative correction of a kinked duplicate origin of the vertebral artery in a patient with dizziness. Case report. Surg Neurol 32:356–359PubMedCrossRefGoogle Scholar
  12. 12.
    Nogueira TE, Chambers AA, Brueggemeyer MT, Miller TJ (1997) Dual origin of the vertebral artery mimicking dissection. AJNR Am J Neuroradiol 18:382–384PubMedGoogle Scholar
  13. 13.
    Kimura K, Yonemitsu M, Hashimoto Y, Uchino M (1997) Spontaneous dissection associated with proximal vertebral artery anomaly. Intern Med 36:834–836PubMedCrossRefGoogle Scholar
  14. 14.
    Goddard AJ, Annesley-Williams D, Guthrie JA, Weston M (2001) Duplication of the vertebral artery: report of two cases and review of the literature. Neuroradiology 43:477–480PubMedCrossRefGoogle Scholar
  15. 15.
    Ionete C, Omojola MF (2006) MR angiographic demonstration of bilateral duplication of the extracranial vertebral artery: unusual course and review of the literature. AJNR Am J Neuroradiol 27:1304–1306PubMedGoogle Scholar
  16. 16.
    Satti SR, Cerniglia CA, Koenigsberg RA (2007) Cervical vertebral artery variations: an anatomic study. AJNR Am J Neuroradiol 28:976–980PubMedGoogle Scholar
  17. 17.
    Lemke AJ, Benndorf G, Liebig T, Felix R (1999) Anomalous origin of the right vertebral artery: review of the literature and case report of right vertebral artery origin distal to the left subclavian artery. AJNR Am J Neuroradiol 20:1318–1321PubMedGoogle Scholar
  18. 18.
    Karcaaltincaba M, Strottman J, Washington L (2003) Multidetector-row CT angiographic findings in the bilateral aortic arch origin of the vertebral arteries. AJNR Am J Neuroradiol 24:157PubMedGoogle Scholar
  19. 19.
    Al-Okaili R, Schwartz ED (2007) Bilateral aortic origins of the vertebral arteries with right vertebral artery arising distal to left subclavian artery: case report. Surg Neurol 67:174–176PubMedCrossRefGoogle Scholar
  20. 20.
    Kau TK, Gasser J, Lesnik G, Sinzig M, Hausegger KA (2008) Images in vascular medicine. Two exceptionally rare branching patterns of the aortic arch. Vasc Med 13:89–90PubMedCrossRefGoogle Scholar
  21. 21.
    Karcaaltincaba M, Haliloglu M, Ozkan E, Kocak M, Akinci D, Ariyurek M (2009) Non-invasive imaging of aberrant right subclavian artery pathologies and aberrant right vertebral artery. Br J Radiol 82:73–78PubMedCrossRefGoogle Scholar
  22. 22.
    Canyigit M, Akgoz A, Koksal A, Yucesoy C (2009) Aberrant right vertebral artery: a rare aortic arch anomaly. Br J Radiol 82:789–791PubMedCrossRefGoogle Scholar
  23. 23.
    Verin AL, Creuze N, Musset D (2010) Multidetector CT scan findings of a right aberrant retroesophageal vertebral artery with an anomalous origin from a cervical aortic arch. Chest 138:418–422PubMedCrossRefGoogle Scholar
  24. 24.
    Dabus G, Walker MT (2010) Right vertebral artery arising from the aortic arch distal to the left subclavian artery diagnosed with magnetic resonance angiography. Arch Neurol 67:508PubMedCrossRefGoogle Scholar
  25. 25.
    Lacout A, Khalil A, Figl A, Liloku R, Marcy PY (2012) Vertebral arteria lusoria: a life-threatening condition for oesophageal surgery. Surg Radiol Anat 34:381–383PubMedCrossRefGoogle Scholar
  26. 26.
    Edwards JE (1948) Anomalies of the derivatives of the aortic arch system. Med Clin North Am 32:925–949PubMedGoogle Scholar
  27. 27.
    Daseler EH, Anson BJ (1959) Surgical anatomy of the subclavian artery and its branches. Surg Gynecol Obstet 108:149–174PubMedGoogle Scholar
  28. 28.
    Argenson C, Francke JP, Sylla S, Dintimille H, Papasian S, di Marino V (1980) The vertebral arteries (segments V1 and V2). Anat Clin 2:29–41CrossRefGoogle Scholar
  29. 29.
    Matula C, Trattnig S, Tschabitscher M, Day JD, Koos WT (1997) The course of the prevertebral segment of the vertebral artery: anatomy and clinical significance. Surg Neurol 48:125–131PubMedCrossRefGoogle Scholar
  30. 30.
    Giuffrè R, Sherkat S (1999) The vertebral artery: developmental pathology. J Neurosurg Sci 43:175–189PubMedGoogle Scholar
  31. 31.
    Padget DH (1948) The development of the cranial arteries in the human embryo. Contrib Embryol 32:207–261Google Scholar
  32. 32.
    Freed K, Low VH (1997) The aberrant subclavian artery. AJR Am J Roentgenol 168:481–484PubMedCrossRefGoogle Scholar
  33. 33.
    Ka-Tak W, Lam WW, Yu SC (2007) MDCT of an aberrant right subclavian artery and of bilateral vertebral arteries with anomalous origins. AJR Am J Roentgenol 188:W274–W275PubMedCrossRefGoogle Scholar
  34. 34.
    Wang K, Zhang M, Sun J, Zhao S (2011) A right-left aortic arch pattern made up by a bicarotid trunk, a left subclavian, a left vertebral and a right retroesophageal subclavian artery. Surg Radiol Anat 33:937–940PubMedCrossRefGoogle Scholar
  35. 35.
    Wasserman BA, Mikulis DJ, Manzione JV (1992) Origin of the right vertebral artery from the left side of the aortic arch proximal to the origin of the left subclavian artery. AJNR Am J Neuroradiol 13:355–358PubMedGoogle Scholar
  36. 36.
    Albayram S, Gailloud P, Wasserman BA (2002) Bilateral arch origin of the vertebral arteries. AJNR Am J Neuroradiol 23:455–458PubMedGoogle Scholar
  37. 37.
    Akdeniz B, Yilmaz E, Pekel N, Ergul BU (2007) Anomalous origin of the right vertebral artery from the ascending aorta in the presence of an aberrant right subclavian artery. Int J Cardiovasc Imaging 23:39–42PubMedCrossRefGoogle Scholar
  38. 38.
    Fujiyama K, Motomura M, Shirabe S, Nakamura T, Isomoto I, Shibayama K, Nagasato K, Yoshimura T, Tsujihata M, Nagataki S (1994) Locked-in syndrome and abnormal orientation of the right vertebral artery in a young man. Intern Med 33:476–480PubMedCrossRefGoogle Scholar
  39. 39.
    Jackson RS, Wheeler AH, 2nd Darden BV (2000) Vertebral artery anomaly with atraumatic dissection causing thromboembolic ischemia: a case report. Spine (Phila PA 1976) 25:1989–1992CrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Akira Uchino
    • 1
  • Naoko Saito
    • 1
  • Masahiro Takahashi
    • 1
  • Yoshitaka Okada
    • 1
  • Eito Kozawa
    • 1
  • Naoko Nishi
    • 1
  • Waka Mizukoshi
    • 1
  • Reiko Nakajima
    • 1
  • Yusuke Watanabe
    • 1
  1. 1.Department of Diagnostic RadiologySaitama Medical University International Medical CenterHidakaJapan

Personalised recommendations